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The Illinois Department of Public Health has received confirmation of approximately 90 cases of cyclosporiasis, an intestinal illness caused by the microscopic Cyclospora parasite, linked to salads sold at McDonald’s restaurants.

Cases have been reported in counties across Illinois with people becoming ill starting in mid-May. About one-fourth of Illinois cases reported eating salads from McDonald’s in the days before they became ill.

The Iowa Department of Health has noted a similar increase in cases.

“Although a link has been made to salads sold in McDonald’s restaurants in some Illinois cases, public health officials continue to investigate other sources,” said IDPH Director Nirav D. Shah, M.D., J.D. “If you ate a salad from McDonald’s since mid-May and developed diarrhea and fatigue, contact a health care provider about testing and treatment.”

The fast food chain is fully cooperating with the state health departments, the Centers for Disease Control and Prevention, and the Food and Drug Administration investigation.

“Out of an abundance of caution, we voluntarily stopped selling salads at impacted restaurants until we can switch to another lettuce blend supplier,” McDonald’s said in an official statement. “We have removed existing lettuce blend from identified restaurants and distribution centers – which includes approximately 3,000 of our U.S. restaurants primarily located in the Midwest.”

McDonald’s says it is in the process of removing these salads from its restaurants and distributions centers. McDonald’s say it is re-supplying restaurants with salads from other suppliers.

People can become infected by consuming food or water contaminated with feces (stool) that contains the parasite. Cyclospora is not spread directly from one person to another.

Symptoms usually begin about a week after exposure, although some people who are infected may not have any. Symptoms may include the following:

Frequent bouts of watery diarrhea (the most common symptom)

Loss of appetite and weight

Cramping, bloating, and/or increased gas

Nausea (vomiting is less common)

Fatigue

Low-grade fever

Cyclospora infection can be treated with specific antibiotics. If not treated, the illness may last for a few days to a month or longer.

Previous cyclosporiasis cases have been linked to various types of imported fresh produce including raspberries, basil, snow peas, and lettuce.

More information can be found on the Centers for Disease Control and Prevention website.